Article(id=1311349836587303418, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202601038, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1767369600000, receivedDateStr=2026-01-03, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579764743, onlineDateStr=2026-09-28, pubDate=1783612800000, pubDateStr=2026-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579764743, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579764743, creator=13701087609, updateTime=1790579764743, updator=13701087609, issue=Issue{id=1311349802038821144, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='1783612800000', pubDateStr='2026-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579756507, creator='13701087609', updateTime=1790588376143, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385955492258162, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385955496452467, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2360, endPage=2365, ext={EN=ArticleExt(id=1311349838109835771, articleId=1311349836587303418, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Factors influencing pneumoconiosis stages and respiratory complications, columnId=1228016570660745413, journalTitle=Modern Preventive Medicine, columnName=Environmental and Occupational Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the risk factors affecting pneumoconiosis stages and the correlation between pneumoconiosis stages and respiratory complications.

Methods

The data were collected from pneumoconiosis patients admitted to West China Fourth Hospital of Sichuan University from 2018 to 2022. The risk factors affecting pneumoconiosis stages were studied by a multivariable ordinal logistic regression model, and the association between pneumoconiosis stages and respiratory complications was analyzed using the Cochran-Armitage trend test.

Results

A total of 564 cases were included in the study, including 144 cases (26%) of stage I, 119 cases (21%) of stage II, and 301 cases (53%) of stage III pneumoconiosis. The results of ordinal logistic regression analysis showed that a duration of dust exposure of more than 20 years (OR=2.380, 95% CI: 1.337-4.238) was a risk factor for higher pneumoconiosis stages (P<0.05). Better self-perception (OR=0.232, 95% CI: 0.086-0.624; OR=0.359, 95% CI: 0.140-0.921; OR=0.140, 95% CI: 0.054-0.360), and high body mass index (BMI≥28.0) (OR=0.391, 95% CI: 0.174-0.878) were protective factors for higher pneumoconiosis stages (P<0.05). The detection rate of respiratory complications was 89.72%. The detection rates of pulmonary tuberculosis (Z=5.495), pleural effusion (Z=2.122),pneumothorax (Z=2.710) and emphysema (Z=3.086) increased with the increase of pneumoconiosis stage, while the detection rate of bronchiectasis (Z=-4.472) decreased with the increase of pneumoconiosis stage (P<0.05).

Conclusion

Occupational disease history and psychological status of patients are important factors affecting the development of pneumoconiosis, and the incidence of respiratory complications increases with the increase of pneumoconiosis stages. Therefore, early prevention should be actively implemented, patients’psychological problems should be addressed, attention should be paid to the prevention and treatment of respiratory complications, and the quality of life of patients should be improved.

, authors=Qiao-lan WANG1, Ya WEN1, Yan-qun WEN1, Lin-shen XIE2, Shi-kun GUO3, authorsList=Qiao-lan WANG, Ya WEN, Yan-qun WEN, Lin-shen XIE, Shi-kun GUO, authorCompany=null, correspAuthors=Shi-kun GUO, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311349839238103552, articleId=1311349836587303418, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=尘肺分期影响因素和呼吸系统合并症分析, columnId=1228016571273113811, journalTitle=现代预防医学, columnName=环境与职业卫生, runingTitle=null, highlight=null, articleAbstract=
目的

分析影响尘肺期别的危险因素以及尘肺不同分期与呼吸系统合并症发病率的关联性。

方法

数据来源于四川大学华西第四医院2018—2022年收治住院的尘肺患者。建立多因素有序逻辑回归模型研究影响患者疾病分期的风险因素;采用Cochran Armitage趋势检验分析尘肺与呼吸系统合并症的相关性。

结果

共纳入研究对象564例,尘肺壹期、尘肺贰期、尘肺叁期患者人数分别为144(26%)、119(21%)和301例(53%)。有序逻辑回归分析结果显示,20年以上接尘时间(OR=2.380,95%CI:1.337~4.238)是尘肺患者更高期别的危险因素(P<0.05);自我感受好者(OR= 0.232,95%CI:0.086~0.624;OR=0.359,95%CI:0.140~0.921;OR=0.140,95%CI:0.054~0.360)、高身体质量指数[(body mass index,BMI≥28.0 kg/m2](OR=0.391,95%CI:0.174~0.878)是尘肺患者更高期别的保护因素(P<0.05)。该研究中呼吸系统合并症检出率高达89.72%,随着尘肺期别增加,合并肺结核(Z=5.495)、胸腔积液(Z=2.122)、气胸(Z=2.710)、肺气肿(Z=3.086)检出率增加,随着患者尘肺期别增加,合并支气管扩张(Z=-4.472)检出率降低(P<0.05)。

结论

患者职业病史和心理状况是影响疾病发展的重要因素,且随期数增加呼吸系统合并症的发病率也随之增加,因此应积极做好前期预防并关注患者心理问题,注重合并症的预防和治疗,提高患者生活质量。

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王侨蓝(1999—),女,硕士,医师,研究方向:劳动卫生与环境卫生

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郭世坤,E-mail:
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Iranian Journal of Public Health, 2025, 54(3): 521-529., articleTitle=Pneumoconiosis and chronic diseases: a narrative review, refAbstract=null)], funds=[Fund(id=1311349851741323827, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, awardId=2021YFS0182, language=CN, fundingSource=四川省科学技术厅重点研发项目(2021YFS0182), fundOrder=null, country=null), Fund(id=1311349851841987124, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, awardId=2022-YF05-01390-SN, language=CN, fundingSource=成都市科学技术局技术创新研发项目(2022-YF05-01390-SN), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311349839577842177, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, xref=1., ext=[AuthorCompanyExt(id=1311349839590425090, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, companyId=1311349839577842177, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Health Monitoring Section, Chenghua District Center for Disease Control and Prevention, Chengdu, Sichuan 610057, China), AuthorCompanyExt(id=1311349839598813699, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, companyId=1311349839577842177, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.成都市成华区疾病预防控制中心卫生监测科,四川 成都 610057)]), AuthorCompany(id=1311349839691088388, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, xref=2., ext=[AuthorCompanyExt(id=1311349839703671301, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, companyId=1311349839691088388, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西公共卫生学院/华西第四医院,职业病医学中心)]), AuthorCompany(id=1311349839779168774, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, xref=3., ext=[AuthorCompanyExt(id=1311349839791751687, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, companyId=1311349839779168774, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.四川大学华西公共卫生学院/华西第四医院尘肺科/呼吸与危重症医学科,四川 成都 610041)])], figs=[ArticleFig(id=1311349847421190697, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=EN, label=Table 1, caption=

Univariate analysis of characteristics of pneumoconiosis in different stages[(), n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量期别合计(n=564)统计量P 值
壹期(n=144)贰期(n=119)叁期(n=301)
年龄(岁)54.72±11.2956.22±9.2956.65±10.361.6900.185
BMI(kg/m2)
<18.511(7.64)8(6.72)33(10.96)52(9.22)6.5830.037
18.5~<24.072(50.00)65(54.62)171(56.81)308(54.61)
24.0~<28.045(31.25)35(29.41)80(26.58)160(28.37)
≥ 28.016(11.11)11(9.24)17(5.65)44(7.80)
接尘时间(年)
<533(22.92)12(10.08)39(12.96)84(14.89)13.0760.001
5~1034(23.61)31(26.05)54(17.94)119(21.10)
11~1525(17.36)28(23.53)69(22.92)122(21.63)
16~2038(26.39)18(15.13)69(22.92)125(22.16)
>2014(9.72)30(25.21)70(23.26)114(20.21)
接尘工种
采矿46(31.94)53(44.54)139(46.18)238(42.20)29.4550.001
掘进43(29.86)32(26.89)87(28.90)162(28.72)
打磨26(18.06)23(19.33)49(16.28)98(17.38)
建筑电焊13(9.03)7(5.88)18(5.98)38(6.74)
维修14(9.72)1(0.84)5(1.66)20(3.55)
其他2(1.39)3(2.52)3(1.00)8(1.42)
粉尘种类
矽尘23(15.97)24(20.17)80(26.58)127(22.52)11.3600.182
碳尘35(24.31)31(26.05)70(23.26)136(24.11)
金属粉尘69(47.92)56(47.06)125(41.53)250(44.33)
人工无机粉尘14(9.72)4(3.36)18(5.98)36(6.38)
混合粉尘3(2.08)4(3.36)8(2.66)15(2.66)
防护工具使用情况
一直佩戴55(38.19)39(32.77)82(27.24)176(31.21)2.5680.277
偶尔佩戴36(25.00)39(32.77)103(34.22)178(31.56)
从未佩戴53(36.81)41(34.45)116(38.54)210(37.23)
自我感受评价
好21(14.58)28(23.53)43(14.29)92(16.31)11.9590.003
较好38(26.39)49(41.18)134(44.52)221(39.18)
一般82(56.94)39(32.77)96(31.89)217(38.48)
差3(2.08)3(2.52)28(9.30)34(6.03)
), ArticleFig(id=1311349849304433194, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=CN, label=表1, caption=

尘肺不同期别特征单因素分析[(),n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量期别合计(n=564)统计量P 值
壹期(n=144)贰期(n=119)叁期(n=301)
年龄(岁)54.72±11.2956.22±9.2956.65±10.361.6900.185
BMI(kg/m2)
<18.511(7.64)8(6.72)33(10.96)52(9.22)6.5830.037
18.5~<24.072(50.00)65(54.62)171(56.81)308(54.61)
24.0~<28.045(31.25)35(29.41)80(26.58)160(28.37)
≥ 28.016(11.11)11(9.24)17(5.65)44(7.80)
接尘时间(年)
<533(22.92)12(10.08)39(12.96)84(14.89)13.0760.001
5~1034(23.61)31(26.05)54(17.94)119(21.10)
11~1525(17.36)28(23.53)69(22.92)122(21.63)
16~2038(26.39)18(15.13)69(22.92)125(22.16)
>2014(9.72)30(25.21)70(23.26)114(20.21)
接尘工种
采矿46(31.94)53(44.54)139(46.18)238(42.20)29.4550.001
掘进43(29.86)32(26.89)87(28.90)162(28.72)
打磨26(18.06)23(19.33)49(16.28)98(17.38)
建筑电焊13(9.03)7(5.88)18(5.98)38(6.74)
维修14(9.72)1(0.84)5(1.66)20(3.55)
其他2(1.39)3(2.52)3(1.00)8(1.42)
粉尘种类
矽尘23(15.97)24(20.17)80(26.58)127(22.52)11.3600.182
碳尘35(24.31)31(26.05)70(23.26)136(24.11)
金属粉尘69(47.92)56(47.06)125(41.53)250(44.33)
人工无机粉尘14(9.72)4(3.36)18(5.98)36(6.38)
混合粉尘3(2.08)4(3.36)8(2.66)15(2.66)
防护工具使用情况
一直佩戴55(38.19)39(32.77)82(27.24)176(31.21)2.5680.277
偶尔佩戴36(25.00)39(32.77)103(34.22)178(31.56)
从未佩戴53(36.81)41(34.45)116(38.54)210(37.23)
自我感受评价
好21(14.58)28(23.53)43(14.29)92(16.31)11.9590.003
较好38(26.39)49(41.18)134(44.52)221(39.18)
一般82(56.94)39(32.77)96(31.89)217(38.48)
差3(2.08)3(2.52)28(9.30)34(6.03)
), ArticleFig(id=1311349849405096491, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=EN, label=Table 2, caption=

Multicollinearity test of independent variables

, figureFileSmall=null, figureFileBig=null, tableContent=
变量VIF容忍度
BMI1.0350.966
接尘时间1.0210.979
接尘工种1.0140.986
自我感受评价1.0280.973
), ArticleFig(id=1311349849488982572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=CN, label=表2, caption=

自变量多重共线性检验

, figureFileSmall=null, figureFileBig=null, tableContent=
变量VIF容忍度
BMI1.0350.966
接尘时间1.0210.979
接尘工种1.0140.986
自我感受评价1.0280.973
), ArticleFig(id=1311349849556091437, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=EN, label=Table 3, caption=

Multivariable ordinal logistic regression analysis of pneumoconiosis stages among patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量B标准误差P 值OR(95%CI)
接尘时间(年,参考组:<5)
>200.8670.2940.0032.380(1.337~4.238)
16~200.4560.2830.1071.578(0.907~4.238)
11~150.4730.2870.0991.605(0.914~2.817)
5~100.0080.2780.9781.008(0.585~1.737)
自我感受评价(参考组:差)
好-1.4630.5060.0040.232(0.086~0.624)
较好-1.0240.4800.0330.359(0.140~0.921)
一般-1.9690.483<0.0010.140(0.054~0.360)
BMI(kg/m2,参考组:<18.5)
≥ 28.0-0.9400.4130.0230.391(0.174~0.878)
24.0~<28.0-0.3630.3350.2780.695(0.361~1.340)
18.5~<24.0-0.3200.3140.3080.726(0.392~1.343)
), ArticleFig(id=1311349849736446510, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=CN, label=表3, caption=

患者分期的多因素有序逻辑回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量B标准误差P 值OR(95%CI)
接尘时间(年,参考组:<5)
>200.8670.2940.0032.380(1.337~4.238)
16~200.4560.2830.1071.578(0.907~4.238)
11~150.4730.2870.0991.605(0.914~2.817)
5~100.0080.2780.9781.008(0.585~1.737)
自我感受评价(参考组:差)
好-1.4630.5060.0040.232(0.086~0.624)
较好-1.0240.4800.0330.359(0.140~0.921)
一般-1.9690.483<0.0010.140(0.054~0.360)
BMI(kg/m2,参考组:<18.5)
≥ 28.0-0.9400.4130.0230.391(0.174~0.878)
24.0~<28.0-0.3630.3350.2780.695(0.361~1.340)
18.5~<24.0-0.3200.3140.3080.726(0.392~1.343)
), ArticleFig(id=1311349851376419375, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=EN, label=Table 4, caption=

Overall distribution of respiratory complications among patients

, figureFileSmall=null, figureFileBig=null, tableContent=
合并症种类患病人数占比(%)
细菌性肺炎41773.94
肺结核21137.41
肺气肿23241.13
肺大泡12622.34
气道高反应407.09
胸腔积液356.21
气胸315.50
呼吸衰竭254.43
支气管扩张203.55
肺空洞152.66
哮喘40.71
), ArticleFig(id=1311349851447722544, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=CN, label=表4, caption=

患者呼吸系统合并症基本分布总人数

, figureFileSmall=null, figureFileBig=null, tableContent=
合并症种类患病人数占比(%)
细菌性肺炎41773.94
肺结核21137.41
肺气肿23241.13
肺大泡12622.34
气道高反应407.09
胸腔积液356.21
气胸315.50
呼吸衰竭254.43
支气管扩张203.55
肺空洞152.66
哮喘40.71
), ArticleFig(id=1311349851527414321, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=EN, label=Table 5, caption=

Association between different pneumoconiosis stages and complications [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
合并症类型期别Z 值P 值
壹期(n=144)贰期(n=119)叁期(n=301)
肺结核35(24.31)29(24.37)147(48.84)5.495<0.001
胸腔积液4(2.78)7(5.88)24(7.97)2.1220.034
气胸4(2.78)2(1.68)25(8.31)2.7100.007
支气管扩张13(9.03)5(4.20)2(0.66)-4.472<0.001
肺气肿42(29.17)53(44.54)137(45.51)3.0860.002
), ArticleFig(id=1311349851623883314, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349836587303418, language=CN, label=表5, caption=

尘肺不同期别与合并症发生相关性分析[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
合并症类型期别Z 值P 值
壹期(n=144)贰期(n=119)叁期(n=301)
肺结核35(24.31)29(24.37)147(48.84)5.495<0.001
胸腔积液4(2.78)7(5.88)24(7.97)2.1220.034
气胸4(2.78)2(1.68)25(8.31)2.7100.007
支气管扩张13(9.03)5(4.20)2(0.66)-4.472<0.001
肺气肿42(29.17)53(44.54)137(45.51)3.0860.002
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尘肺分期影响因素和呼吸系统合并症分析
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王侨蓝 1 , 温雅 1 , 文艳群 1 , 谢林伸 2 , 郭世坤 3
现代预防医学 | 环境与职业卫生 2026,53(13): 2360-2365
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现代预防医学 |环境与职业卫生 2026 , 53 (13) : 2360 -2365
尘肺分期影响因素和呼吸系统合并症分析
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王侨蓝1, 温雅1, 文艳群1, 谢林伸2, 郭世坤3
作者信息
  • 1.成都市成华区疾病预防控制中心卫生监测科,四川 成都 610057
  • 2.四川大学华西公共卫生学院/华西第四医院,职业病医学中心
  • 3.四川大学华西公共卫生学院/华西第四医院尘肺科/呼吸与危重症医学科,四川 成都 610041
通讯作者:
郭世坤,E-mail:
作者简介:

王侨蓝(1999—),女,硕士,医师,研究方向:劳动卫生与环境卫生

Factors influencing pneumoconiosis stages and respiratory complications
Qiao-lan WANG1, Ya WEN1, Yan-qun WEN1, Lin-shen XIE2, Shi-kun GUO3
Affiliations
  • Health Monitoring Section, Chenghua District Center for Disease Control and Prevention, Chengdu, Sichuan 610057, China
出版时间: 2026-07-10 doi: 10.20043/j.cnki.MPM.202601038
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目的

分析影响尘肺期别的危险因素以及尘肺不同分期与呼吸系统合并症发病率的关联性。

方法

数据来源于四川大学华西第四医院2018—2022年收治住院的尘肺患者。建立多因素有序逻辑回归模型研究影响患者疾病分期的风险因素;采用Cochran Armitage趋势检验分析尘肺与呼吸系统合并症的相关性。

结果

共纳入研究对象564例,尘肺壹期、尘肺贰期、尘肺叁期患者人数分别为144(26%)、119(21%)和301例(53%)。有序逻辑回归分析结果显示,20年以上接尘时间(OR=2.380,95%CI:1.337~4.238)是尘肺患者更高期别的危险因素(P<0.05);自我感受好者(OR= 0.232,95%CI:0.086~0.624;OR=0.359,95%CI:0.140~0.921;OR=0.140,95%CI:0.054~0.360)、高身体质量指数[(body mass index,BMI≥28.0 kg/m2](OR=0.391,95%CI:0.174~0.878)是尘肺患者更高期别的保护因素(P<0.05)。该研究中呼吸系统合并症检出率高达89.72%,随着尘肺期别增加,合并肺结核(Z=5.495)、胸腔积液(Z=2.122)、气胸(Z=2.710)、肺气肿(Z=3.086)检出率增加,随着患者尘肺期别增加,合并支气管扩张(Z=-4.472)检出率降低(P<0.05)。

结论

患者职业病史和心理状况是影响疾病发展的重要因素,且随期数增加呼吸系统合并症的发病率也随之增加,因此应积极做好前期预防并关注患者心理问题,注重合并症的预防和治疗,提高患者生活质量。

尘肺  /  分期  /  危险因素  /  合并症
Objective

To analyze the risk factors affecting pneumoconiosis stages and the correlation between pneumoconiosis stages and respiratory complications.

Methods

The data were collected from pneumoconiosis patients admitted to West China Fourth Hospital of Sichuan University from 2018 to 2022. The risk factors affecting pneumoconiosis stages were studied by a multivariable ordinal logistic regression model, and the association between pneumoconiosis stages and respiratory complications was analyzed using the Cochran-Armitage trend test.

Results

A total of 564 cases were included in the study, including 144 cases (26%) of stage I, 119 cases (21%) of stage II, and 301 cases (53%) of stage III pneumoconiosis. The results of ordinal logistic regression analysis showed that a duration of dust exposure of more than 20 years (OR=2.380, 95% CI: 1.337-4.238) was a risk factor for higher pneumoconiosis stages (P<0.05). Better self-perception (OR=0.232, 95% CI: 0.086-0.624; OR=0.359, 95% CI: 0.140-0.921; OR=0.140, 95% CI: 0.054-0.360), and high body mass index (BMI≥28.0) (OR=0.391, 95% CI: 0.174-0.878) were protective factors for higher pneumoconiosis stages (P<0.05). The detection rate of respiratory complications was 89.72%. The detection rates of pulmonary tuberculosis (Z=5.495), pleural effusion (Z=2.122),pneumothorax (Z=2.710) and emphysema (Z=3.086) increased with the increase of pneumoconiosis stage, while the detection rate of bronchiectasis (Z=-4.472) decreased with the increase of pneumoconiosis stage (P<0.05).

Conclusion

Occupational disease history and psychological status of patients are important factors affecting the development of pneumoconiosis, and the incidence of respiratory complications increases with the increase of pneumoconiosis stages. Therefore, early prevention should be actively implemented, patients’psychological problems should be addressed, attention should be paid to the prevention and treatment of respiratory complications, and the quality of life of patients should be improved.

Pneumoconiosis  /  Stages  /  Risk factors  /  Complications
王侨蓝, 温雅, 文艳群, 谢林伸, 郭世坤. 尘肺分期影响因素和呼吸系统合并症分析. 现代预防医学, 2026 , 53 (13) : 2360 -2365 . DOI: 10.20043/j.cnki.MPM.202601038
Qiao-lan WANG, Ya WEN, Yan-qun WEN, Lin-shen XIE, Shi-kun GUO. Factors influencing pneumoconiosis stages and respiratory complications[J]. Modern Preventive Medicine, 2026 , 53 (13) : 2360 -2365 . DOI: 10.20043/j.cnki.MPM.202601038
尘肺病是一种由于吸入生产性粉尘潴留于肺内而导致肺部纤维化的疾病[1-2],是职业病中危害最严重的[3]一种,目前仍是我国最主要的职业病类型[4]。该疾病的发生发展过程中会对肺部造成进行性不可逆的损害,劳动者即使脱离粉尘接触后仍可继续恶化,不仅对个人的健康状况和生活质量产生持续影响,还会给患者家庭带来巨大经济负担[5]。
临床上根据疾病特征将其分为尘肺壹、贰、叁期[6],但目前针对不同期别患者均缺乏有效的根治方法[7],是一类没有医疗终结的疾病,且薄弱的肺部状态极易使患者合并各类呼吸系统疾病[8],使其处于长期带病生存、与病共存的状态[9]。然而其又是一类病因明确的疾病,可对影响该疾病发展的危险因素采取有效预防和干预措施以延缓疾病发展[10]。既往研究表明尘肺患者高期别和患有合并症是影响其生活质量和生存时间的危险因素[11-12]。因此,本研究首先分析影响尘肺患者分期的风险因素,以识别可能发展为高期别患者的高危人群;其次,探究不同期别下尘肺患者的呼吸系统合并症发生规律,分析其发生率随期别增加的变化趋势,探索高期别下患者的疾病状况,通过将风险因素分析与合并症规律探究相结合,旨在为尘肺病的早期干预与精准管理提供一定依据。
本研究数据来源于四川大学华西第四医院,选取2018年1月—2022年4月在该院的尘肺住院患者作为研究对象,导出病例信息后对其初步整理筛选出样本742例,将出院诊断中有明确尘肺分期诊断的患者纳入研究,最终有效研究对象为564例。
纳入标准:(1)尘肺病诊断以及分期诊断符合《GBZ 70—2015职业性尘肺病的诊断》[6]、中华预防医学会劳动卫生与职业病分会职业性肺部疾病学组制定的《尘肺病治疗中国专家共((2018年版)》诊断标准[8];(2)相关合并症疾病均符合其诊断标准;(3)个人信息完整且配合随访调查。排除标准:病例中资讯不完整(包括个人信息大量缺失、无医学诊断尘肺以及分期等)、不配合随访等。对纳入的研究对象采用电话随访形式进行调查,以补充缺失信息。本研究已获得四川大学华西第四医院医学伦理委员会批准(HXSY-EC-2021053)。本研究利用以往临床诊疗数据,豁免知情同意。
根据研究对象病史信息、出院诊断信息并结合既往文献确定最终需要纳入研究的因素:一是与疾病分期相关的特征变量,包括个人信息[年龄、身体质量指数(body mass index,BMI)]、职业病史(接尘时间、接尘工种、粉尘种类、防护工具使用情况)、自我感受评价;二是呼吸系统合并症检出情况相关信息。
采用R统计软件(https://www.r-project.org)[核心package:mice包、MASS:polr( )函数、DescTools-Cochran ArmitageTest( )函数],采用多重插补法进行缺失值补充,计量资料用(均数±标准差)表示,计数资料用频数和百分数(%)表示;组间资料比较采用方差分析、χ2检验,资料不满足正态分布或等级资料采用Kruskal-Wallis H秩和检验;在多因素分析中,构建有序逻辑回归模型分析影响疾病分期的风险因素;尘肺分期与合并症相关性分析采用Cochran Armitage趋势检验,检验标准为α=0.05。
本研究最终纳入研究对象564例,尘肺壹期、贰期、叁期患者人数分别为144、119和301例。564例患者均为男性,平均年龄为(56.07±10.41)岁,平均BMI为(22.98±3.63)kg/m2。对于不同期别尘肺患者的年龄、BMI、接尘时间、接尘工种、粉尘种类、防护工具使用情况、自我感受评价进行比较,结果显示BMI、接尘时间、接尘工种、自我感受评价在不同期别的差异有统计学意义。见表1。
在采用有序逻辑回归模型进行多因素分析时,需要对研究变量以及模型进行检验,包括多重共线性检验和平行性检验,以验证各变量之间相关性以及是否满足比例优势假设。既往文献资料表明,当方差膨胀因子(variance inflation factor,VIF)<5时,提示各变量之间多重共线性较弱[13],当平行性检验P>0.05时[14],平行性检验通过,模型符合有序逻辑回归的比例优势。该研究中结果显示多重共线性检验和平行性检验均通过。见表2。
以尘肺患者不同期别作为因变量,上述单因素分析中具有差异的因素,包括BMI、接尘时间、接尘工种、自我感受评价纳入回归模型中。结果显示,BMI、接尘时间、自我感受评价是影响患者分期的重要因素,大于20年接尘时间(OR=2.380,95%CI:1.337~4.238)是尘肺患者更高期别的危险因素(P<0.05);自我感受好者(OR=0.232,95%CI:0.086~0.624;OR=0.359,95%CI:0.140~0.921;OR=0.140,95%CI:0.054~0.360)、高BMI(≥28.0 kg/m2)(OR=0.391,95%CI:0.174~0.878)是尘肺患者更高期别的保护因素(P<0.05)。见表3。
本研究中尘肺患者合并症检出率高达99.65%(562/564),呼吸系统合并症检出率高达89.72%(507/564),其中细菌性肺炎占比最高,其后依次为肺结核、肺气肿、肺大泡、气道高反应、胸腔积液、气胸、呼吸衰竭、支气管扩张、肺空洞、哮喘。见表4。
采用Cochran Armitage趋势检验分析尘肺病分期与其呼吸系统合并症就患病率之间的关系,结果发现随着患者尘肺期别增加,并发肺结核(Z=5.495)、胸腔积液(Z=2.122)、气胸(Z=2.710)、肺气肿(Z=3.086)也随之增加,随着患者尘肺期别增加,并发支气管扩张(Z=-4.472)降低,且其具有统计学意义。见表5。
本研究中尘肺壹期、贰期、叁期患者分别占比26%、21%、53%,在不同研究中尘肺患者期别比例差异较大[15-17],可能是由于不同研究样本来源不同,该研究对象均来源于住院患者,本身病情较为严重,因此造成了叁期患者占比较大的现象。
本研究显示长时间接触粉尘是影响患者疾病发展的危险因素,有学者指出接尘时间在一定程度上反映了患者暴露于职业病危害因素的情况,随暴露时间增加粉尘积累剂量也增加,对劳动者肺部功能伤害加重[18],导致患者成为更高期别的风险增加。研究还发现,自我感受评价与尘肺期别之间存在统计学关联。本研究的结果显示,自我感受评价为差的患者,其处于更高尘肺期数的可能性较高,提示患者的自我感受评价或可作为反映疾病进展状态的一个参考。尘肺期别越高、病情越重的患者,由于疾病本身带来的对生理健康影响以及经济负担等容易出现消极心理问题[19-20],可表现为焦虑抑郁情绪。然而,两者之间也可能存在相互影响的恶性循环机制,疾病加重导致自我感受变差,而这种消极的自我评价和心理状态等会降低患者疾病管理能力,削弱治疗依从性,影响疾病系统正规治疗,从而间接对疾病进程产生不利影响[21]。基于以上发现,建议针对尘肺患者积极开展健康教育和心理干预,使患者获得社会支持以改善心理状况[22-23],提升患者整体生存质量。
除此之外,在该研究中还显示肥胖的患者相较于偏瘦患者而言是尘肺高期别的保护因素,近来一些研究发现高BMI对慢性疾病的预后有着积极作用[24],BMI较高患者可能具有更好的营养状态以及更强大的免疫功能,以帮助身体更好地对抗尘肺引起的炎症和其他合并症,有助于提高预后[25]。然而,尽管有这些证据支持,也不能忽视过于超重带来的其他健康问题。例如,过于肥胖可能增加患者心血管疾病的风险[26],对于BMI大于30 kg/m2的患者,抗高血压和降脂治疗仅能降低一半的心血管疾病风险[27],这些疾病可能反而会影响尘肺患者的预后。总的来说,在我们研究结果中BMI大于28.0 kg/m2会给尘肺患者预后带来积极影响,因此,在评估BMI与尘肺患者期别的影响时,需要综合考虑患者的整体健康状况,以更好地指导尘肺患者的管理和治疗。
本研究中尘肺患者呼吸系统合并症检出率高达89.72%,占比前三的为细菌性肺炎、肺结核、肺气肿,这也与王玉辉[28]相关研究结果类似。我们发现随着尘肺期别增加,肺结核、胸腔积液、气胸、肺气肿发病率也随之增加,同既往文献结果一致[29-30]。随着疾病的发展,加重破坏肺部弹性纤维和平滑肌,导致病变组织以及纤维化范围扩大,肺通气功能障碍进一步发展,使得肺功能损伤程度加重的同时也为其他致病菌的生长繁殖提供了有利机会[31],在多重原因下导致上述呼吸系统系列合并症发生率增加。此外,结果还显示随着尘肺期别增加,支气管扩张发生率降低,既往文献指出因检查手段限制,症状隐匿,支气管扩张发现率一般较低,可能本研究结果与此原因[32]有一定关系,此外由于研究收集的数据资料以及研究对象受限等原因可能都是导致该合并症和既往大多数研究结果不一致的原因。尘肺合并症会增加治疗难度,影响患者整体预后,严重者直接影响患者的生存时间[33-34]。因此应加强职业健康监护,做好干预,延缓疾病发展,减少合并症发生,提高患者生命质量。
本研究也存在若干局限性。一是纳入的研究对象均为住院病例,来源单一,数据有一定的选择偏倚;二是纳入的变量较少,可能会把与患者疾病发展相关的重要因素遗漏,比如职业病史的具体暴露剂量、个人生活史的吸烟情况等;三是该研究为横断面设计,所有变量均为同一时间节点收集,难以确定变量之间关联的方向。例如,BMI于入院后测量,该变量在尘肺病程中既可能作为风险因素影响疾病进展,但也可能是疾病严重而引起的低BMI结局,自我感受评价变量也是类似的状况,最终分析结果可能会存在反向因果的情况。在后续研究中会尽可能收集多波纵向数据,多纳入与疾病相关的变量,采用交叉滞后方法来验证关联变量的时序关系,以更准确地识别影响尘肺期别发展的危险因素。
综上,本研究结果显示,长时间接尘、消极心理状态是影响尘肺期别的风险因素,高BMI是其保护因素;且随尘肺期别增加呼吸系统各合并症检出率也随之增加。临床上可通过识别高危因素暴露者,将其作为重点监测对象,并针对性地开展干预与管理措施,如对长时间粉尘暴露者实施调岗、对低BMI患者开展适宜的营养支持、对消极情绪患者进行心理干预等,以降低患者疾病发展风险,从而进一步减少患者发生呼吸系统合并症的风险,降低死亡风险,为尘肺病的个体化风险评估和分层管理提供一定的依据。
  • 四川省科学技术厅重点研发项目(2021YFS0182)
  • 成都市科学技术局技术创新研发项目(2022-YF05-01390-SN)
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2026年第53卷第13期
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doi: 10.20043/j.cnki.MPM.202601038
  • 接收时间:2026-01-03
  • 首发时间:2026-09-28
  • 出版时间:2026-07-10
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  • 收稿日期:2026-01-03
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四川省科学技术厅重点研发项目(2021YFS0182)
成都市科学技术局技术创新研发项目(2022-YF05-01390-SN)
作者信息
    1.成都市成华区疾病预防控制中心卫生监测科,四川 成都 610057
    2.四川大学华西公共卫生学院/华西第四医院,职业病医学中心
    3.四川大学华西公共卫生学院/华西第四医院尘肺科/呼吸与危重症医学科,四川 成都 610041

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2种不同金属材料的力学参数
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genus
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species
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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